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Recent documents in Scholarshipen-usFri, 29 Jul 2016 01:51:10 PDT3600Premature Infant Oral Motor Intervention (PIOMI): Translating Interventional Research into Interdisciplinary Practicehttp://digitalcommons.iwu.edu/nursing_scholarship/29
http://digitalcommons.iwu.edu/nursing_scholarship/29Wed, 27 Jul 2016 09:01:14 PDT
Translating interventional research into practice requires a multifaceted approach. Rogers’ (2003) diffusion of innovations (DOL) model provides a framework within which to implement a new intervention into practice. The model asserts that the adoption of an innovation is influenced by the nature of the innovation and the manner in which it is communicated to users in a social system. The Premature Infant Oral Motor Intervention (PIOMI) was developed by a nurse researcher with expertise in neonatal science, in collaboration with an expert in oral motor therapy. The safety and efficacy of the new intervention was tested (Lessen, 2011), followed by a formal study on its reliability. Adoption of this innovative intervention must target several disciplines including medicine, nursing, occupational therapy, and speech-language therapy. The process of a neonatal intensive care unit adopting the PIOMI as the standard of oral motor therapy practice among disciplines is described using the DOL model, and the specific training program is presented, including its modifications after formal reliability testing. With the reliability of the PIOMI documented and accurate training issues identified and corrected, further studies on its efficacy should be pursued. Presented at the at the 12th National Neonatal Nurses Conference and 15th National Mother Baby Nurses Conference, Chicago, IL, September 6-8, 2012. Abstracts published by Neonatal Network: The Journal of Neonatal Nursing.
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Brenda LessenEffect of the Premature Infant Oral Motor Intervention on Feeding Progression and Length of Stay in Preterm Infantshttp://digitalcommons.iwu.edu/nursing_scholarship/28
http://digitalcommons.iwu.edu/nursing_scholarship/28Wed, 27 Jul 2016 09:01:11 PDT
Purpose: Preterm infants frequently experience oral feeding difficulties due to underdeveloped oral motor skills and the lack of coordination of sucking, swallowing, and respiration. The infants’ ability to consume all feedings orally while maintaining physiologic stability and weight gain is necessary for their discharge. Therefore, difficulty with oral feeding leads to longer hospital stays and higher costs. For example, with more than half a million of premature infants born each year, a 3-day decrease in hospital stay would save more than 2 billion dollars annually. There is a need for evidenced-based interventions that facilitate development of oral-motor skills, leading to improved oral feeding, thus shortening hospital stays and lowering costs. The purpose of this research was to test the newly developed Premature Infant Oral Motor Intervention (PIOMI) beginning at 29 weeks postmenstrual age (PMA), before oral feedings were introduced, to determine whether the prefeeding intervention would result in a shorter transition from gavage to total oral feedings and a shorter length of hospital stay (LOS). The PIOMI is a 5-minute oral motor intervention that provides assisted movement to activate muscle contraction and provides movement against resistance to build strength. The focus of the intervention is to increase functional response to pressure and movement and control of movements for the lips, cheeks, jaw, and tongue. The cheeks (internal and external), lips, gums, tongue, and palate were stimulated per specific protocol with finger stroking. Subjects: A total of 19 infants from 1 level III NICU born between 26 and 29 weeks PMA: 10 in the experimental group and 9 in the control group. Design: A randomized, blinded, clinical trial was conducted to examine outcomes related to the newly developed PIOMI. Methods: Beginning at 29 weeks PMA (and before the introduction of oral feeding), the experimental group received the PIOMI for 5 minutes per day for 7 consecutive days. The control group received a sham intervention to keep staff and parents blinded to the infants’ group assignment. Physiological and behavioral stabilities were continually assessed throughout the intervention. A chart review was then conducted to compare the transition from gavage feeding to total oral feedings between the experimental and control group, as well as LOS. Results: The PIOMI was well tolerated by 29-week PMA infants, as evidenced by physiological and behavioral cues. Infants who received the once-daily PIOMI transitioned from their first oral feeding to total oral feedings 5 days sooner than controls (P = .043) and were discharged 2.6 days sooner than controls. Conclusion: This pilot work supports further study on the use of the PIOMI with preterm infants to enhance oral-feeding skills and decrease LOS.
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Brenda LessenEffect of Oral Stimulation on Feeding Progression in Preterm Infantshttp://digitalcommons.iwu.edu/nursing_scholarship/27
http://digitalcommons.iwu.edu/nursing_scholarship/27Wed, 27 Jul 2016 09:01:09 PDT
This is a poster presentation of original research conducted to assess the safety and efficacy of a newly developed prefeeding oral stimulation intervention (Beckman Oral Motor Intervention-Premature Infant) on feeding progression and length of stay on preterm infants younger than 30 weeks PMA.
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Brenda LessenReliability of the Premature Infant Oral Motor Intervention (PIOMI)http://digitalcommons.iwu.edu/nursing_scholarship/26
http://digitalcommons.iwu.edu/nursing_scholarship/26Wed, 27 Jul 2016 09:01:06 PDT
Problem/Literature Review: Recent multidisciplinary research continues to examine various types of oral motor therapy in preterm infants but none have formally tested the reliability of specific oral motor interventions. The premature infant oral motor intervention (PIOMI) is a five minute, pre-feeding intervention developed to improve feeding skills. As further research is planned, the reliability of the intervention needed to be tested. The purpose of this study was to determine the interobserver, interuser, and test-retest reliability of the PIOMI, as well as determining if the specific training program developed was sufficient enough to reach high reliabilities. Methodology: The study was conducted at a Level III NICU using a purposeful convenience sample. A specific training plan was established, and a reliability rating tool was developed. Two observers rated three RNs performing the PIOMI twice each on premature infants. Data Analysis: The PIOMI demonstrated overall high percent agreement for interobserver (97.57 percent), interuser (97.59 percent), and test-retest (97.58 percent) reliabilities. However, three specific steps of the 8-step intervention yielded weaker reliabilities, directing modifications of the training program. Interpretation: Strong reliability is essential to assure that an intervention can be fully and properly implemented before translating evidence-based interventions into practice, and the importance of effective training to achieve high levels of reliability is discussed. This study suggests that with a specific training program the PIOMI can be reliably performed among different RNs (interuser) and by the same RN more than once (test-retest). Using the reliability rating tool the PIOMI can also be reliably rated by different observers (interobserver). With the reliability of the PIOMI documented and accurate training issues identified and corrected, further studies on its efficacy should be pursued. Presented at the 12th National Neonatal Nurses Conference and 15th National Mother Baby Nurses Conference, Chicago, IL, September 6-8, 2012. Abstracts published in Neonatal Network: The Journal of Neonatal Nursing.
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Brenda Lessen et al.Establishing Intervention Fidelity of an Oral Motor Intervention for Preterm Infantshttp://digitalcommons.iwu.edu/nursing_scholarship/25
http://digitalcommons.iwu.edu/nursing_scholarship/25Wed, 27 Jul 2016 09:01:04 PDT
Purpose: To establish intervention fidelity of the premature infant oral motor intervention (PIOMI) Design and sample: A rating tool was developed and tested for interrater reliability before being used to test the fidelity of intervention behaviors. A purposeful convenience sample of three users was recruited to perform the intervention under direct observation. Main outcome variables: Three types of reliabilities were calculated: (1) interrater reliability to test the rating tool, followed by (2) interuser reliability, and (3) test–retest reliabilities to test the intervention behaviors of several registered nurses (RNs) over repeated performances of the intervention. Results: The rating tool demonstrated a high interrater reliability (97.57 percent), indicating its accuracy for systematically rating the specific intervention behaviors. Subsequently, the rating tool was used to determine interuser and test–retest performances of the PIOMI and resulted in high reliabilities (97.59 percent and 97.58 percent, respectively). This demonstrates that the intervention can be reliably delivered as prescribed, supporting intervention fidelity.
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Brenda Lessen et al.Positive outcome after looped peripherally inserted central catheter malposition. A case study.http://digitalcommons.iwu.edu/nursing_scholarship/24
http://digitalcommons.iwu.edu/nursing_scholarship/24Wed, 27 Jul 2016 09:01:02 PDT
Tip malposition of peripherally inserted central catheters (PICCs) is a frequently encountered problem. Invasive and noninvasive techniques for resolution of malpositions described in the literature are reviewed. A positive outcome using non-invasive techniques after a looped malposition in the axillary vein is discussed.
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Noel KerrCross Cultural Perspectives on Nursing: A Glimpse of Nursing in Japanhttp://digitalcommons.iwu.edu/nursing_scholarship/23
http://digitalcommons.iwu.edu/nursing_scholarship/23Wed, 27 Jul 2016 09:00:59 PDTNoel KerrAMSN Board votes to support the Coalition for Patient's Rightshttp://digitalcommons.iwu.edu/nursing_scholarship/22
http://digitalcommons.iwu.edu/nursing_scholarship/22Wed, 27 Jul 2016 09:00:57 PDTNoel Kerr'Creating a Protective Picture:' A Grounded Theory of RN Decision Making When Using a Charting-by-Exception Documentation Systemhttp://digitalcommons.iwu.edu/nursing_scholarship/21
http://digitalcommons.iwu.edu/nursing_scholarship/21Wed, 27 Jul 2016 09:00:55 PDT
The philosophy behind charting-by-exception (CBE) remains a source of professional concern almost 30 years after its introduction. The literature lacks both qualitative and quantitative studies that address staff nurse views of CBE or the use of CBE data for clinical decision making. Purpose The specific aim of this study was to explore the decision making of medical-surgical nurses who use CBE as their method of documentation. Method Grounded theory was used to explore how medical-surgical nurses decide whether to follow a CBE policy on a day-to-day, patient-by-patient basis. Approval of the AMSN Research Committee and the Rutgers University Institutional Review Board was obtained. Telephone interviews were conducted with 16 registered nurses, recruited from the AMSN membership, working in staff nurse positions on an acute care medical-surgical unit who described their perspectives and experiences in using CBE to document clinical data. Interviews were recorded and transcribed verbatim, and these data were analyzed using the constant comparative method as described by Glaser (1998). Findings The theory that emerged is a three-step process which includes Coming to Terms with the Method, Being Responsible in Documentation, and Creating a Protective Picture (CAPP). CAPP is the core category that explains how the participants resolved their main concern - creating documentation they believed would be protective of their patients, themselves, and/or their employers. Conclusion The theory provides insight into what nurses consider responsible documentation practices and the decision-making process they use when documenting under a CBE policy with an exception-based electronic documentation system.
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Noel KerrPreoperative Stoma Site Assessment and Markinghttp://digitalcommons.iwu.edu/nursing_scholarship/19
http://digitalcommons.iwu.edu/nursing_scholarship/19Wed, 27 Jul 2016 09:00:50 PDTNoel Kerr et al.Take the Plunge: Expanding the Float Pool to "Closed" Unitshttp://digitalcommons.iwu.edu/nursing_scholarship/18
http://digitalcommons.iwu.edu/nursing_scholarship/18Wed, 27 Jul 2016 09:00:48 PDT
Techniques were developed based on nursing staff input to improve floating at a 500-bed trauma center when the practice was expanded to include units that were previously closed. Written fact sheets were prepared for each unit, and a buddy system was implemented for all floats. A study was conducted to identify the effects of these and other interventions designed to improve nurses' experience of floating.
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Noel Kerr et al.The Family Experience with Eating Disorders Scale: Psychometric Analysishttp://digitalcommons.iwu.edu/nursing_scholarship/17
http://digitalcommons.iwu.edu/nursing_scholarship/17Wed, 27 Jul 2016 09:00:45 PDT
The role of the family in the development and maintenance of eating disorders is frequently cited in the literature; however, common methodological issues, including the use of diverse family assessment instruments with inadequate psychometric properties, exist. Further, variables specific to families with eating disorder are not being captured in available instruments. The modeling and role-modeling theory (Erickson, H., Kinney, C. (Eds). 1990. Modeling and role-modeling: Theory, practice, and research. Austin, TX: Society for Advancement of Modeling and Role-Modeling; Erickson, H. Tomlin, E., Swain, M. A.1983. Modeling and role-modeling: A theory and paradigm for nursing. Englewood Cliffs, NJ: Prentice-Hall.) was employed to structure the Family Experience with Eating Disorders Scale (FEEDS), a 53-item instrument that measures variables specific to families with eating disorder. An adequate degree of reliability and validity of the FEEDS was demonstrated with a multisite sample composed of three groups:146 parents of individuals with eating disorders, 35 parents of adolescents with psychiatric disorders, and 100 parents of college students with no known psychiatric illness. Structural equation modeling supported the construct validity of a reduced 30-item instrument and confirmed three higher order measurement models. A provisional degree of known group validity was established. Tests of internal consistency and testretest at 2 weeks demonstrated adequate reliability. The FEEDS could be a useful adjunct to clinical assessment and could be instrumental in designing nursing interventions and measuring treatment outcomes for families with eating disorder.
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Victoria FolseSelf-Concept and Sexualityhttp://digitalcommons.iwu.edu/nursing_scholarship/16
http://digitalcommons.iwu.edu/nursing_scholarship/16Wed, 27 Jul 2016 09:00:43 PDT
In press. Visit http://www.us.elsevierhealth.com/Nursing to check availability.
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Victoria FolseSelf-Concepthttp://digitalcommons.iwu.edu/nursing_scholarship/15
http://digitalcommons.iwu.edu/nursing_scholarship/15Wed, 27 Jul 2016 09:00:40 PDT
This new edition addresses the increased focus on evidence-based practice and new guidelines for safe patient handling. Plus, a new, cutting-edge chapter on Surviving Cancer helps prepare you to address the unique health care needs of patients who have survived cancer, but still face the physical and emotional after-effects of the illness and its therapy. Order information at http://www.us.elsevierhealth.com/specialty.jsp?lid=4&sid=415
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Victoria FolseManaging Quality and Riskhttp://digitalcommons.iwu.edu/nursing_scholarship/14
http://digitalcommons.iwu.edu/nursing_scholarship/14Wed, 27 Jul 2016 09:00:39 PDT
In press. Visit http://www.us.elsevierhealth.com/Nursing to check availability.
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Victoria FolseConflict: The Cutting Edge of Changehttp://digitalcommons.iwu.edu/nursing_scholarship/13
http://digitalcommons.iwu.edu/nursing_scholarship/13Wed, 27 Jul 2016 09:00:37 PDT
In press. Visit http://www.us.elsevierhealth.com/Nursing to check availability.
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Victoria FolseSuicide Risk Screening in an Emergency Department: Engaging Staff Nurses in Continued Testing of a Brief Instrumenthttp://digitalcommons.iwu.edu/nursing_scholarship/10
http://digitalcommons.iwu.edu/nursing_scholarship/10Wed, 27 Jul 2016 09:00:31 PDT
A study was conducted to detect suicide risk in adolescents and adults seeking treatment in an emergency department (ED) in the Midwest as well as to continue testing reliability and validity of the 4-item Risk of Suicide Questionnaire (RSQ) developed by Horowitz et al. This study included ED staff nurses in a Level II Trauma Center who administered the RSQ to adolescent, adult, and geriatric patients, regardless of chief complaint or psychiatric history. Participants consisted of a convenience sample of 202 patients composed of 59 adolescents and 143 adults, including 36 geriatric patients. Psychometric analysis demonstrated a lower-than-expected degree of reliability and an adequate level of criterion-related validity for the RSQ in this sample. Interrater reliability was established. Approximately 42% of all patients who participated screened positive for suicide risk using the RSQ. Results support screening by nurses as part of the admission assessment to determine suicide risk in patients who present to the ED. DOI: 10.1177/1054773809335296
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Victoria Folse et al.Detecting Suicide Risk in Adolescents and Adults in an Emergency Department: A Pilot Studyhttp://digitalcommons.iwu.edu/nursing_scholarship/9
http://digitalcommons.iwu.edu/nursing_scholarship/9Wed, 27 Jul 2016 09:00:29 PDT
The investigators conducted a pilot study to detect suicide risk in adolescents and adults seeking treatment in an emergency department, as well as to test the reliability and validity of the 4-item Risk of Suicide Questionnaire (RSQ). This study expanded the implementation of the RSQ beyond its initial use with children and adolescents with psychiatric symptoms who were seeking treatment in a pediatric emergency department to include adolescent and adult patients in a Level I trauma center. An advanced practice psychiatric nurse verbally administered the RSQ to a convenience sample of 104 emergency department patients ages 12 to 82. Psychometric analysis demonstrated an adequate degree of reliability and criterion-related validity for the RSQ. Approximately 30% of all patients who participated screened positive for suicide risk. The results support the continued use of the 4-item RSQ with all adolescents and use of a reduced 2-item form of the RSQ with adults exhibiting psychiatric chief complaints to determine imminent risk of suicide in patients who seek treatment in the emergency department. Nurses in all health care settings need to initiate suicide screening and implement nursing interventions directed toward suicide prevention.
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Victoria Folse et al.Fatigue as a symptom of Acute Myocardial Infarctionhttp://digitalcommons.iwu.edu/nursing_scholarship/8
http://digitalcommons.iwu.edu/nursing_scholarship/8Wed, 27 Jul 2016 09:00:27 PDT
Fatigue may be a commonly experienced symptom of acute myocardial infarction (AMI); however, there is a disturbing lack of data about the fatigue that occurs among men and women at the time of AMI. The purpose of this study was to characterize the fatigue experienced among men and women during AMI using three validated fatigue questionnaires.
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Ann Eckhardt et al.Psychometric Properties of Three Instruments to Measure Fatigue with Myocardial Infarctionhttp://digitalcommons.iwu.edu/nursing_scholarship/7
http://digitalcommons.iwu.edu/nursing_scholarship/7Wed, 27 Jul 2016 09:00:25 PDT
The purpose of this study was to evaluate the psychometric properties of three questionnaires to measure fatigue with myocardial infarction. The Fatigue Symptom Inventory Interference Scale, Profile of Moods States Fatigue subscale (POMS-F), and Short Form 36 (SF-36) Vitality Scale were completed during hospitalization (n = 116) and 30 days after hospital admission (n = 49). Moderate to strong correlations were found among each of these fatigue scales and between each fatigue scale and measures of other variables to include vigor, depressed mood, anxiety, and physical functioning. POMS-F scores decreased significantly at Time 2, but this decline in fatigue was not validated on the other fatigue scales. Patients’ Time 1 scores reflected significantly more fatigue compared to published scores for healthy adults. The ability to discriminate between groups suggests that the instruments may be useful for identifying patients with cardiovascular risk factors who report clinically significant fatigue.
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Ann Eckhardt et al.Gender Differences in Fatigue Associated With Acute Myocardial Infarctionhttp://digitalcommons.iwu.edu/nursing_scholarship/6
http://digitalcommons.iwu.edu/nursing_scholarship/6Wed, 27 Jul 2016 09:00:22 PDT
Fatigue is a symptom of acute myocardial infarction (AMI); however, few studies have characterized the fatigue associated with AMI in men and women.
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Ann Eckhardt et al.Fatigue in the Presence of Coronary Heart Diseasehttp://digitalcommons.iwu.edu/nursing_scholarship/5
http://digitalcommons.iwu.edu/nursing_scholarship/5Wed, 27 Jul 2016 09:00:20 PDT
Fatigue is a prevalent and disabling symptom associated with many acute and chronic conditions. It has been identified as a symptom of acute myocardial infarction and chronic heart failure, but it has not been explored in patients with stable coronary heart disease (CHD). Objectives: The purpose of this partially mixed sequential dominant status study was to: 1) describe fatigue in patients with stable CHD, 2) determine if specific demographic (sex, age, education, income), physiologic (hypertension, hyperlipidemia) or psychological variables (depressive symptoms) were correlated with fatigue, and 3) determine if fatigue was associated with health-related quality of life. The theory of unpleasant symptoms was used as a conceptual framework to guide the study design and aims. Methods: Patients (N =102) attending two cardiology clinics were enrolled and completed the Fatigue Symptom Inventory, Patient Health Questionnaire-9, and the Medical Outcomes Study Short Form-36 to measure fatigue, depressive symptoms, and health-related quality of life. Thirteen patients whose interference from fatigue was low, moderate, or high participated in qualitative interviews. Results: Forty percent of the sample reported fatigue more than 3 days of the week lasting more than one-half of the day. Lower interference from fatigue was reported on standardized measures compared to qualitative interviews. Women reported a higher fatigue intensity (t = 2.27; p = 0.003) and more interference from fatigue (t = 2.74; p = 0.007) compared to men. In regression analyses, depressive symptoms were the sole predictor of fatigue intensity and interference. Discussion: Stable CHD patients reported clinically relevant levels of fatigue. Patients with stable CHD may discount fatigue as they adapt to their symptoms. Relying solely on standardized measures may provide an incomplete picture of fatigue burden in patients with stable CHD.
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Ann Eckhardt et al.Women’s Early Warning Symptoms of Acute Myocardial Infarctionhttp://digitalcommons.iwu.edu/nursing_scholarship/4
http://digitalcommons.iwu.edu/nursing_scholarship/4Wed, 27 Jul 2016 09:00:18 PDT
Background— Data remain sparse on women’s prodromal symptoms before acute myocardial infarction (AMI). This study describes prodromal and AMI symptoms in women.Methods and Results— Participants were 515 women diagnosed with AMI from 5 sites. Using the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey, we surveyed them 4 to 6 months after discharge, asking about symptoms, comorbidities, and demographic characteristics. Women were predominantly white (93%), high school educated (54.8%), and older (mean age, 66±12), with 95% (n=489) reporting prodromal symptoms. The most frequent prodromal symptoms experienced more than 1 month before AMI were unusual fatigue (70.7%), sleep disturbance (47.8%), and shortness of breath (42.1%). Only 29.7% reported chest discomfort, a hallmark symptom in men. The most frequent acute symptoms were shortness of breath (57.9%), weakness (54.8%), and fatigue (42.9%). Acute chest pain was absent in 43%. Women had more acute (mean, 7.3±4.8; range, 0 to 29) than prodromal (mean, 5.71±4.36; range, 0 to 25) symptoms. The average prodromal score, symptom weighted by frequency and intensity, was 58.5±52.7, whereas the average acute score, symptom weighted by intensity, was 16.5±12.1. These 2 scores were correlated (r=0.61, P<0.001). Women with more prodromal symptoms experienced more acute symptoms. After controlling for risk factors, prodromal scores accounted for 33.2% of acute symptomatology.Conclusions— Most women have prodromal symptoms before AMI. It remains unknown whether prodromal symptoms are predictive of future events.
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Ann Eckhardt et al.Using Clinical Journaling to Capture Critical Thinking Across the Curriculumhttp://digitalcommons.iwu.edu/nursing_scholarship/3
http://digitalcommons.iwu.edu/nursing_scholarship/3Wed, 27 Jul 2016 09:00:14 PDT
Describes the use of clinical journaling as an integrated teaching methodology throughout the practicum component of a baccalaureate nursing program at Bradley University, Peoria, Illinois. Nursing students complete a weekly log for each clinical rotation; Students identify learning goals, analyze events and relate them to nursing practice, use critical thinking to connect theory and practice, and reflect on the experience.
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Jacklyn Ruthman et al.Feeding readiness in preterm infants: the relationship between preterm behavioral state and feeding readiness behaviors and efficiency during transition from gavage to oral feedinghttp://digitalcommons.iwu.edu/nursing_scholarship/2
http://digitalcommons.iwu.edu/nursing_scholarship/2Wed, 27 Jul 2016 09:00:12 PDT
The purpose of this secondary analysis was to assess whether alert behavioral states were associated with an increased number of feeding readiness behaviors (FRBs) and whether the number of FRBs were associated with subsequent feeding efficiency in healthy premature infants born between 29 to 35 weeks gestation. (post-print forthcoming)
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R. White-Traut et al.On Vs Off: Perceptions of Four Patients’ Experiences of Coronary Artery Bypass Surgeryhttp://digitalcommons.iwu.edu/nursing_scholarship/1
http://digitalcommons.iwu.edu/nursing_scholarship/1Wed, 27 Jul 2016 09:00:09 PDT
The benefits of Off-Pump Coronary Artery Bypass surgery (OPCAB) are well documented, but little information is available that explores the patient’s perception of the experience. The purpose of this study was to explore the differences in perceptions and experiences in patients who have undergone both OPCAB and onpump Coronary Artery Bypass Grafting procedures. Guided by naturalistic inquiry, semistructured qualitative interviews were conducted and audio taped with 4 men living independently. Inductive analysis of the transcripts revealed 7 themes: general comparisons, health care seeking symptoms, loss of control, faith and trust, postoperative depression, interactions with health care professionals, and sharing the life-time experience. The findings from this study will help to guide future research in the area of cardiovascular surgery.
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